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Up-front Hepatic Resection for Metastatic Colorectal Cancer Results in Favorable Long-term Survival

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 25 November 2012

Abstract

Background

Hepatic metastasis from colorectal cancer (CRC) is best managed with a multimodal approach; however, the optimal timing of liver resection in relation to administration of perioperative chemotherapy remains unclear. Our strategy has been to offer up-front liver resection for patients with resectable hepatic metastases, followed by post–liver resection chemotherapy. We report the outcomes of patients based on this surgical approach.

Methods

A retrospective review of all patients undergoing liver resection for CRC metastases over a 5-year period (2002–2007) was performed. Associations between clinicopathologic factors and survival were evaluated by the Cox proportional hazard method.

Results

A total of 320 patients underwent 336 liver resections. Median follow-up was 40 (range 8–80) months. The majority (n = 195, 60.9 %) had metachronous disease, and most patients (n = 286, 85 %) had a major hepatectomy (>3 segments). Thirty-six patients (11 %) received preoperative chemotherapy, predominantly for downstaging unresectable disease. Ninety-day mortality was 2.1 %, and perioperative morbidity occurred in 68 patients (20.2 %). Actual disease-free survival at 3 and 5 years was 46.2 % and 42 %, respectively. Actual overall survival (OS) at 3 and 5 years was 63.7 % and 55 %, respectively. Multivariate analysis identified four factors that were independently associated with differences in OS (hazard ratio; 95 % confidence interval): size of metastasis >6 cm (2.2; 1.3–3.5), positive lymph node status of the primary CRC (N1 (2.0; 1.0–3.8), N2 (2.4; 1.2–4.9)), synchronous disease (2.1; 1.3–3.5), and treatment with chemotherapy after liver resection (0.42; 0.23–0.75).

Conclusions

Up-front surgery for patients with resectable CRC liver metastases, followed by chemotherapy, can lead to favorable OS.

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Authors and Affiliations

  1. Department of Surgery, Queen’s University, Kingston, ON, Canada

    Sulaiman Nanji MD, PhD

  2. Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

    Sean Cleary MD, MSc, Subani Selvarajah MD, Paul Grieg MD, Ian McGilvary MD, PhD, Bryce Taylor MD, Alice Wei MD, MSc, Carol-Anne Moulton MD, PhD & Steven Gallinger MD, MSc

  3. Department of Pathology, University of Toronto, Toronto, ON, Canada

    Paul Ryan MD

  4. Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Centre, Los Angeles, CA, Canada

    Maha Guindi MD

Authors
  1. Sulaiman Nanji MD, PhD
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  2. Sean Cleary MD, MSc
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  3. Paul Ryan MD
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  11. Steven Gallinger MD, MSc
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Correspondence to Steven Gallinger MD, MSc.

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Nanji, S., Cleary, S., Ryan, P. et al. Up-front Hepatic Resection for Metastatic Colorectal Cancer Results in Favorable Long-term Survival. Ann Surg Oncol 20, 295–304 (2013). https://doi.org/10.1245/s10434-012-2424-1

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  • DOI: https://doi.org/10.1245/s10434-012-2424-1

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